““Humanitarian Action” Humanitarian Action” The Saint-Petersburg The Saint-Petersburg

Charitable Foundation for Charitable Foundation for Medical and Social Medical and Social

ProgramsPrograms

HAFHAF

June 2001 – date of official June 2001 – date of official registration of the Foundationregistration of the Foundation

HAF was created on the basis of HAF was created on the basis of projects of “Medecins du Monde – projects of “Medecins du Monde – France” in Saint Petersburg France” in Saint Petersburg

All HAF programs All HAF programs include activities related include activities related

to HIVto HIV

WHY?WHY?

Epidemic situation in Russia in Epidemic situation in Russia in 2004 2004

305 242 registered HIV cases since 305 242 registered HIV cases since starting the epidemic processstarting the epidemic process

Number of deaths caused by AIDSNumber of deaths caused by AIDS 6 350, 6 350, includingincluding 302 302 childrenchildren

11 530 11 530 children born from HIV+ children born from HIV+ mothersmothers

HIV in RussiaHIV in RussiaNegative tendencies during 2 Negative tendencies during 2

last yearslast years

Increasing on Increasing on 87% 87% of mortality among HIV+ of mortality among HIV+

people people

2,7 times increasing of number of children 2,7 times increasing of number of children

born from HIV+ mothersborn from HIV+ mothers

Increasing on 189% of HIV infected children Increasing on 189% of HIV infected children

and adolescentsand adolescents

HIV in St Petersburg in 2004HIV in St Petersburg in 2004Numbers of casesNumbers of cases

HIV Epidemics in St Petersburg in HIV Epidemics in St Petersburg in 20042004

DuringDuring 2004 2004 the number of new cases the number of new cases was was 4 576 4 576

165 165 new cases among young people new cases among young people aged 15 -18 yearsaged 15 -18 years

Since Since 1987 1987 toto 2004 2004 number of deaths number of deaths due to HIV was ofdue to HIV was of 1004 1004, including 122 , including 122 people in the stage of AIDSpeople in the stage of AIDS

HIV in St Petersburg in 2004HIV in St Petersburg in 2004

A decrease of 10% of new HIV A decrease of 10% of new HIV cases is observed among all cases is observed among all groups of population. groups of population. Young people Young people 15 – 29 15 – 29 years old years old areare 74,9% 74,9% of all number of HIV + of all number of HIV +

HIV in St Petersburg in 2004HIV in St Petersburg in 2004Ways of transmissionWays of transmission

HIV in St Petersburg in 2004HIV in St Petersburg in 2004

The parenteral way is still very The parenteral way is still very important (65,1%)important (65,1%)

But less important than 1n 2003 (87%)But less important than 1n 2003 (87%)

HIV in St Petersburg in 2004HIV in St Petersburg in 2004Sex ratioSex ratio

HIV in St Petersburg in 2004HIV in St Petersburg in 2004Dinamics of sexual and parenteral ways of Dinamics of sexual and parenteral ways of

transmissiontransmission

HIV in St Petersburg in 2004HIV in St Petersburg in 2004Age groupsAge groups

HIV in St Petersburg in 2004HIV in St Petersburg in 2004Number of HIV+ pregnant womenNumber of HIV+ pregnant women

HAF programs HAF programs in Saint Petersbourgin Saint Petersbourg

Program of medical, social, psychological Program of medical, social, psychological help to street children – since 1995help to street children – since 1995

Harm reduction program for drug users – Harm reduction program for drug users – since 1997since 1997

HIV prevention program among street HIV prevention program among street commercial female sex workers – since commercial female sex workers – since 20002000

Out-patient center run in partnership with Out-patient center run in partnership with the Botkin hospitalthe Botkin hospital

TB prevention among HIV+ peopleTB prevention among HIV+ people Working out adherance in treatment Working out adherance in treatment

among IDU (case management)among IDU (case management) Lobbying of HR and of access to treatment Lobbying of HR and of access to treatment

for IDU for IDU

Medical, social and Medical, social and psychological help to street psychological help to street

kidskidsMain services:Main services:

- Outreach workOutreach work- Day drop-in centre for consultationsDay drop-in centre for consultations- Short term night centreShort term night centre- VVССT (HIV, hepatitis, syphilis)T (HIV, hepatitis, syphilis)

Prevention information provided in all Prevention information provided in all moduls.moduls.

A constant contact with the street

is provided by the intensified street and outreach work

Medical consultationsMedical consultations

Since 7 years more than 4000 children were provided with help within the framework of the program activities

Risks related to the street lifeRisks related to the street life

   Engaging in criminal structures or Engaging in criminal structures or activitiesactivities

   Absence of social protectionAbsence of social protection

Sanitary risksSanitary risks

Sanitary risksSanitary risks

PromiscuityPromiscuity Drug useDrug use Absence of informationAbsence of information

Street children and drugsStreet children and drugs

   19919988 20020044

TobaccoTobacco 329 (55,6%)329 (55,6%) 726 (74,5%)726 (74,5%)

Heavy drugsHeavy drugs 50 (8,5%)50 (8,5%) 324 (33,3%)324 (33,3%)

SniffingSniffing 88 (14,9%)88 (14,9%) 223 (22,9%)223 (22,9%)

AlcoholAlcohol 169 (28,6%)169 (28,6%) 597 (61,3%)597 (61,3%)

Comparative evaluation of the HIV-rate Comparative evaluation of the HIV-rate ((for for 1000 1000 populationpopulation, 2002), 2002)

4,18

104,4

0

20

40

60

80

100

120

Saint-Pet in general

Street children

Testing resultsTesting results

0,62,3

23,8

4,1

0,8

8,7

19,8

9,510,8

5,6

23,6

6,2

10,4

0,8

25,6

1,60

5

10

15

20

25

30

1999 2000 2001 2002

HIV Hepatitis B Hepatitis C Syphilis

Average age of HIV-positive Average age of HIV-positive street childrenstreet children

15,9 15,9 years oldyears old

What next?

Harm Reduction programHarm Reduction program

Bus – an outreach unitBus – an outreach unit

Provided services:Provided services:- Needle exchangeNeedle exchange- Distribution of condomsDistribution of condoms- InformationInformation- Medical and psychological consultationsMedical and psychological consultations- VCT (HIV, hepatitis B and C, syphilis)VCT (HIV, hepatitis B and C, syphilis)

Harm reduction bus activities in Harm reduction bus activities in 20042004

Number of clients - Number of clients - 11906906Number of visits - Number of visits - 8 200 8 200 Number of exchanged syringes - Number of exchanged syringes - 232 232

000 000 Number of tested people - Number of tested people - 563 563

20.7% - positive results20.7% - positive resultsAverage age of clients:Average age of clients:- women -women -23,323,3 - men men 25,525,5Main drug – heroine (85%)Main drug – heroine (85%)

HIV prevention program forHIV prevention program for street street commercial sex workerscommercial sex workers

Van – an outreach unitVan – an outreach unit

Provided services:Provided services:- Condoms’ distributionCondoms’ distribution- Needle exchangeNeedle exchange- InformationInformation- Medical and psychological Medical and psychological

consultationsconsultations- VCT (HIV, hepatitis B and C, syphilis)VCT (HIV, hepatitis B and C, syphilis)

Data for 2004Data for 2004

Number of street female commercial sex-Number of street female commercial sex-workers (CSW) - workers (CSW) - 8000–100008000–10000

95% of them are intravenous drug users 95% of them are intravenous drug users (UDVI)(UDVI)

Number of contacts - Number of contacts - 88764764 Number of women contacted - Number of women contacted - 21216969 Number of condoms distributed - Number of condoms distributed - 56621 56621 Number of syringes distributed – Number of syringes distributed – 6300063000 Average age – Average age – 23,923,9

Infections among female CSWInfections among female CSWStudy of the end of 2003Study of the end of 2003

HIV – 48%HIV – 48% Syphilis – 44%Syphilis – 44%

Lobbying of HR andLobbying of HR and access to access to treatment. Why?treatment. Why?

- HR is still rather tolerated but not really HR is still rather tolerated but not really accepted by the authoritiesaccepted by the authorities

- Drug use is criminalizedDrug use is criminalized- Access to health structures is very Access to health structures is very

difficultdifficult- No political will of government to change No political will of government to change

situationsituation

Photo: Hans Jürgen Burkard

Access to treatmentAccess to treatment

About 150 people receive ARV in St About 150 people receive ARV in St PetersburgPetersburg

About 300 need ARV and are on the About 300 need ARV and are on the waiting list, but real need unknownwaiting list, but real need unknown

IDU are practically excluded of this IDU are practically excluded of this numbernumber

What is being done by HAF?What is being done by HAF?

- Creation of a network of specialists of Creation of a network of specialists of concerned medical structures and concerned medical structures and trainings for themtrainings for them

- Trainings for police officersTrainings for police officers- Creation of an out-patient structure in the Creation of an out-patient structure in the

Botkin hospital for infectious diseasesBotkin hospital for infectious diseases- Institutional development of the Institutional development of the

community of PLWHAcommunity of PLWHA

IDUs as percent of registered IDUs as percent of registered HIV/AIDS cases; IDUs as recipients HIV/AIDS cases; IDUs as recipients

of any form ARVof any form ARV

18%

82%

23%

77%

IDUsNon-IDUs

Source: Central and Eastern European Harm Reduction Network, 2002

Causes of Discrimination Causes of Discrimination against IDU’s in Health Care against IDU’s in Health Care

SettingsSettings

41%

27%

18%

14% Dr.'s beliefs

Registration of IDUnames at hospitals

Sharing of informationw/law enforcement

Other (e.g. notreatment if not drugfree)

Three necessary components for an Three necessary components for an effective response to HIV in our effective response to HIV in our

regionregion Scaled up prevention efforts for Scaled up prevention efforts for

vulnerable populations – drug users, vulnerable populations – drug users, sex workers, street kidssex workers, street kids

HIV care for everyone that needs it HIV care for everyone that needs it with special attention paid to with special attention paid to marginalized groupsmarginalized groups

Reassessment of drug policies and Reassessment of drug policies and bringing them in line with European bringing them in line with European discourse discourse

Alexander TsekhanovichAlexander TsekhanovichHumanitarian Action FoundationHumanitarian Action Foundation

197197 110, Russia, Saint-Petersburg 110, Russia, Saint-PetersburgOfitsersky pereulok 6-2Ofitsersky pereulok 6-2

+7 812 237 14 95+7 812 237 14 95+7 812 237 18 21+7 812 237 18 21

www.humanitarianaction.orgwww.humanitarianaction.orgoffice@humanitarianaction.orgoffice@humanitarianaction.org